Patient Education

ATOPIC DERMATITIS

Copyright 2002, Regional Allergy & Asthma Consultants, PA

WHAT IS ATOPIC DERMATITIS?

Atopic dermatitis is a type of eczema in which the skin is fundamentally too dry. This overly dry skin is quite itchy, and patients with this condition tend to scratch. The scratched areas then become more red and inflamed. Hence, atopic dermatitis is sometimes called the "itch that rashes."

Atopic dermatitis can occur anywhere on the body, and in fact the skin is usually too dry everywhere. In older children and adults, the inflamed areas most commonly involve the inner creases of the knees and elbows, the tops of the hands and feet, the neck, and the trunk. Babies have more prominent involvement of the face, forearms, and legs.

WHO GETS ATOPIC DERMATITIS?

Atopic dermatitis is much more common in patients with a family history of allergies for two reasons: 1) the genes that cause skin dryness are very closely linked to the genes that cause allergy, and 2) some cases of atopic dermatitis are actually caused by, or at least aggravated by, an allergic reaction to some foods.

Atopic dermatitis usually develops in the first year or two of life. Most often, but not always, the condition will gradually improve with age. Because of the strong association with allergy, many patients may "outgrow" their atopic dermatitis, only to develop nasal allergies or asthma later in childhood. Some will develop all three, the so-called " allergic triad."

WHAT CAUSES ATOPIC DERMATITIS?

The fundamental cause of atopic dermatitis in virtually all cases is an inherited tendency toward dry skin. Various environmental factors may aggravate this condition. Cold, dry weather will typically worsen atopic dermatitis by causing further dryness of the skin. As a result, the winter season may be particularly troublesome for patients with atopic dermatitis. On the other hand, overly hot and humid weather will sometimes aggravate the condition as well, since salt in perspiration can be quite irritating. Wool and synthetic fabrics, like polyester and nylon, can irritate the skin as well. Stress and anxiety are also common triggers.

About one-third of children and a minority of adults with more severe atopic dermatitis have an allergy to one, and occasionally more, foods. Eating that food will cause their eczema to flare. In young children, egg, milk, soy, and peanut are major culprits. Finally, some allergic patients have worsening of their atopic dermatitis, along with their nasal allergy or asthma, when they are exposed to dust mites, animal danders, or pollen.

HOW IS ATOPIC DERMATITIS EVALUATED?

We take a careful history to identify all possible aggravating factors and to assess for any related conditions, such as allergies or asthma. We perform a thorough exam of the skin to determine the extent and severity of the eczema. In many cases we will perform allergy testing to determine if anything in the diet or environment should be avoided.

HOW IS ATOPIC DERMATITIS TREATED?

The fundamental backbone of treatment is moisturizing the skin.  This is usually accomplished by bathing, as often as you wish, with a nonirritating, moisturizing soap such as Dove Unscented, Basis, or Lever 2000.  Immediately following bathing, gently pat the skin partly dry, and, while the skin is still moist, lightly apply an over-the-counter lubricating ointment or cream (such as Eucerin cream, Aquaphor, or Vaseline petroleum jelly) to the whole body.  Lotions should be avoided, as they contain alcohol, are usually irritating, and provide only limited moisture.  Reapply the lubricating agent after each bath or shower and as often as needed in between bathing to maintain good skin hydration. 

 

We usually prescribe a steroid cream or ointment to be used only on areas of inflamed skin.  Examples include Hydrocortisone, Elocon, Triamcinalone, and Valisone.  These are generally used only as long as needed, and are best avoided on the face or around the eyes unless specifically prescribed for such.  The steroid cream or ointment is best applied to affected areas before applying the lubricating agent, since the lubricating agent could block the medicine from soaking in well enough. 

 

For patients with more severe dermatitis, or for those requiring treatment on the face, or who have not responded to a steroid cream, we may use a non-steroidal ointment called Protopic or Elidel.  This is applied twice daily.

 

It is usually helpful to take an antihistamine to control itch and prevent scratching, particularly in children and at nighttime.  We may prescribe an antihistamine that reduces itch and causes drowsiness for use at night, and then one of the newer non-sedating antihistamines for use during the day. 

 

Sometimes, the skin with atopic dermatitis will become infected with a bacteria or fungus.  When this happens, you may notice worsening of the eczema, and often some yellowish crusting or oozing from the skin.  In these cases a course of antibiotics or antifungals will usually be quite helpful in improving the skin condition. 

 

If we have identified any particular food or environmental allergens that are aggravating your eczema, we will advise you how to avoid these items.  In general, allergy immunotherapy injections are not useful in treating atopic dermatitis, except in circumstances where exposure to pollens, molds, dust mites, or animal dander is causing significant nasal allergies or asthma in addition to flares of dermatitis. 

 

Finally, in severe cases of atopic dermatitis, we may work together with a dermatologist to recommend the best therapy for your skin. 

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